Summit County

Public Health Assessment and Wellness

Dispense-Assist

State: KS
Type: Model Practice
Year: 2012

ABSTRACT:

All health departments across the United States are tasked with planning for and responding to biological disasters, in some instances this can include providing emergency prophylaxis for the entire jurisdictional population, for the Johnson County Health Department this means planning to dispense medication to 550,000 within 48hours of a known incident. After previous dispensing methodologies were determined to be financially and logistically unfeasible, JCHD began to investigate alternatives. Finding none that worked for this specific population, JCHD staff looked into creating their own screening tool. Subject matter experts within the Kansas City region were identified and assembled into the development team that created what is now www.DispenseAssist.com. Financial sustainability and universal access were determined to be basic tenants of the project as the D-A Team quickly discovered that the challenges their agency faced were shared by other jurisdictions throughout the region.

ORGANIZATION:

Johnson County Department of Health & Environment

TITLE:

Dispense-Assist

All health departments across the United States are tasked with planning for and responding to biological disasters, in some instances this can include providing emergency prophylaxis for the entire jurisdictional population, for the Johnson County Health Department this means planning to dispense medication to 550,000 within 48hours of a known incident. After previous dispensing methodologies were determined to be financially and logistically unfeasible, JCHD began to investigate alternatives. Finding none that worked for this specific population, JCHD staff looked into creating their own screening tool. Subject matter experts within the Kansas City region were identified and assembled into the development team that created what is now www.DispenseAssist.com. Financial sustainability and universal access were determined to be basic tenants of the project as the D-A Team quickly discovered that the challenges their agency faced were shared by other jurisdictions throughout the region.
The agencies that are comprised in the Kansas Public Health Region 15 represent a wealth of diversity, with some jurisdictions having dense urban populations, sprawled suburban communities and even further divided rural areas. Finding a solution that would fit all of these groups would be a challenge, but the D-A development team insisted that the final product support emergency preparedness efforts for all jurisdictions regardless for geographical size, population count, technical expertise, and funding streams. Creating a system that was financially sustainable meant avoiding reliance on software that required recurring licensure fees and sharing costs across jurisdictional boundaries when necessary. The resulting system is hosted by a regional designee and readily accessible by any agency or organization at any time with no log-on or password required. There was initial discussion about whether or not to prevent the public from accessing the site and it was the decided that the public should not only be able to have the same level of access to the website as a government agency, but that they should be encouraged to play with the system and thus familiarize themselves with the process.
Technical specifications of the system were initially designed to support the usage of the entire Kansas City metropolitan region, a population of roughly 2M residents, should an incident of that scope occur. After external agencies expressed interest in using the system, the D-A Team began investigating enhancing system capacity to support usage by multiple Metropolitan areas. The first version of Dispense-Assist became available in the spring of 2011 and underwent alpha testing during a regional full-scale exercise. At this time areas of improvement were identified and the system was adjusted based on comments made during and after the exercise. The soft launch of the website occurred in late summer 2011 which provided additional feedback and resulted in further refinement of the system just in time for flu season. The system is currently slated for formal launch which will include the posting of a comprehensive user’s guide and support documents all available for download off of the D-A website.

Health Issues
Public Health agencies are tasked with preparing for and responding to biological emergencies, this includes maintaining the ability to provide emergency prophylaxis to all residents and visitors within 48hours of a known exposure. This presents a challenge to all jurisdictions. Client screening has often been one of the most time-consumptive operations at a point of dispensing, so methods of reducing through-put times is a high-priority for many PHEP programs. Dispense-Assist allows individuals and client representatives to complete documentation in advance of an incident and effectively remove the screening team from a POD site.
The importance of Public Health Emergency Preparedness was emphasized following the 2001 anthrax attacks which resulted in five deaths and 17 infected individuals. The creation of the PHEP program was aimed at addressing the threat of future attacks and additional biological emergencies such as pandemic influenza. After years of practicing point of dispensing operations, client screening remained a challenge which often required more staff and more time that what was available. Dispense-Assist alleviates strain on the PODs by allowing medication screening to occur prior to a POD opening. In addition, at-risk and vulnerable populations, such as those with cognitive issues and the incarcerated, can be better served working with their established social service representative in a Closed POD setting.
Dispense-Assist provides algorithm-based screening for Category A agents and seasonal influenza. Once a user has entered their demographic and health screening information into the website, a printable voucher is created that can be exchanged for vaccine or medication. This screening tool is open to the public and any interested agency at any time, free of charge. Internet access is also not a barrier to using D-A as a plug-and-play version is also available.
Innovation
No other system existed that met the following qualifiers: free to use, not agency-specific, available 24/7, screens for flu and Category A agents, accessible by both the public and emergency preparedness professionals.
Dispense-Assist is the first and only non-jurisdictional online screening tool for both for Category A biological agents and seasonal influenza. By encouraging the public to use the system during routine flu vaccination clinics, we facilitate the practice of the same process that will be used during a biological emergency. Additionally, use of the website is free and available for any organization, any agency anywhere to use at any time. Supporting documents will be available for download November 2011 to assist agencies and organizations with implementation and usage of Dispense-Assist.

Primary Stakeholders
Involvement of local and regional partners in the development of Dispense-Assist was essential to establishing buy-in. Representatives from Kansas Public Health Region 15, Kansas City Kansas Regional Hospital Group, Cass County Missouri Public Health, and Independence Missouri Public Health all provided input and funding to support the project.
Role of Stakeholders/Partners
Multiple health departments and hospitals throughout the Kansas City Metro Region tested the first version of Dispense-Assist during a spring 2011 full-scale exercise. Following the soft-launch of the website, D-A users tested the influenza screening tool during their annual flu clinics.
LHD Role
The primary development team was located at the Johnson County Health Department and was comprised of a PHEP Planner who served as the project lead, the regional Cities Readiness Coordinator, health department nurses and frontline staff who would be supporting the system during a mass dispensing operation.
Planning initiatives that include representatives from at-risk populations are currently underway. The resulting process will support mass prophylaxis dispensing through a series of Closed PODs. Additional Closed PODS will be facilitated through partnerships with multiple school districts, hospitals and even detention facilities.
Lessons Learned
When developing planning strategies for a diverse constituency, it’s important to avoid making assumptions and develop operational methods that accommodate the specific needs of a community group. In working with these identified groups, all efforts should be taken to empower members of the public while supporting their individual sovereignty
Implementation Strategy
Financial sustainability and universal access were determined to be basic tenants of the project as the D-A Team quickly discovered that the challenges their agency faced were shared by other jurisdictions throughout the region. The agencies that are comprised in the Kansas Public Health Region 15 represent a wealth of diversity, with some jurisdictions having dense urban populations, sprawled suburban communities and even further divided rural areas. Finding a solution that would fit all of these groups would be a challenge, but the D-A development team insisted that the final product support emergency preparedness efforts for all jurisdictions regardless for geographical size, population count, technical expertise, and funding streams. Creating a system that was financially sustainable meant avoiding reliance on software that required recurring licensure fees and sharing costs across jurisdictional boundaries when necessary. The resulting system is hosted by a regional designee and readily accessible by any agency or organization at any time with no log-on or password required. There was initial discussion about whether or not to prevent the public from accessing the site and it was the decided that the public should not only be able to have the same level of access to the website as a government agency, but that they should be encouraged to play with the system and thus familiarize themselves with the process. Technical specifications of the system were initially designed to support the usage of the entire Kansas City metropolitan region, a population of roughly 2M residents, should an incident of that scope occur. After external agencies expressed interest in using the system, the D-A Team began investigating enhancing system capacity to support usage by multiple Metropolitan areas.
The first version of Dispense-Assist became available in the spring of 2011 and underwent alpha testing during a regional full-scale exercise. At this time areas of improvement were identified and the system was adjusted based on comments made during and after the exercise. The soft launch of the website occurred in late summer 2011 which provided additional feedback and resulted in further refinement of the system just in time for flu season. The system is currently slated for formal launch which will include the posting of a comprehensive user’s guide and support documents all available for download off of the D-A website.

Process & Outcome
Prior to implementing Dispense-Assist the number of open PODS required to dispense prophylaxis materials to 550,000 in 48 hours was 11 with a staffing count of 154 per shift, with Dispense-Assist the number of PODs required is 8 with a staffing count of 70 which is an overall staffing reduction of 67%. Throughput times were collected from the 2011 Spring Fever exercise and compared against data collected during previous drills. Capacity was gauged using throughput modeling software RealOpt. Prior to implementing Dispense-Assist the number of open PODS required to dispense prophylaxis materials to 550,000 in 48 hours was 11 with a staffing count of 154 per shift, with Dispense-Assist the number of PODs required is 8 with a staffing count of 70 which is an overall staffing reduction of 67%. Data regarding the significant improvement in both throughput counts and overall staffing was shared with regional partners who then decided whether or not to implement Dispense-Assist within their agency or organization.
Objective 1: Regional partnerships supported long-term sustainability. There is no charge to use the system. Free access helps facilitate usage by agencies and organizations that face financial challenges.
Objective 2: By making the system universal (no agency-specific wording or logos) any jurisdiction can send their clients to www.dispenseassist.com via a link on their website for a seamless user experience. By not charging for use any agency or organization is welcome to use the system at any time.
Objective 3: Inclusion of end-users during the development phase and candid discussion following field tests has helped refine the system based on what real users wanted and avoided unnecessary assumptions.

There is significant support for Dispense-Assist in the Kansas City Metro Region with the following agencies currently using the system:
Johnson County KS Health Department
Wyandotte County KS Health Department
Leavenworth County KS Health Department
Linn County KS Health Department
Miami County KS Health Department
City of Independence MO Health Department
Cass County MO Health Department
Platte County MO Health Department
In addition, numerous hospital organizations around the region are transitioning to the Dispense-Assist system. Regional planning initiatives through the Mid-America Regional Council and state-specific planning regions support the use of D-A through shared financial and staff training strategies.